How to combat fake drugs without harming the poor

The most recent example of a fake medicine coming into the U.S. was not sold over the Internet; rather, it came wholesale from Canada. In March, fakes of Avastin, which probably originated in the Middle East, went to traders in Denmark, Britain and Canada, before arriving in clinics in California, Illinois and Texas. At least one patient in Corpus Christi, Texas, actually took the fake.

Officials in both Canada and the U.S. are still working through who is to be charged for what offenses in relation to the importation of the potentially dangerous products. Some U.S. doctors could lose their licenses or even face criminal charges for buying the fakes.

The North American trader of the fake Avastin is also the brother-in-law of the CEO of one of Canada’s largest Internet pharmacies, Canadadrugs.com. While the Internet drug business is entirely separate from the wholesale business, if Canadadrugs’ CEO condoned or benefited from the trade, as informed sources indicate to me he did, then the Internet business will be the focus of the attention, because Canadadrugs is a well-known name. That would be unfortunate because the real problem is not Canadian Internet pharmacies but the international wholesale drug business.

As long as Middle Eastern, Chinese and Indian businessmen can make fake drugs without much likelihood of discovery or prosecution, someone will always work out ways to get those drugs into the U.S. supply chain. Current U.S. government approaches to this problem focus on increasing intellectual property enforcement and having more FDA inspectors to oversee foreign production plants. FDA inspections will spot some problems with products exported to the U.S. IP law is also valuable, but pushing IP law aggressively, as U.S. industry and government do, creates politically influential commercial opponents in nations we need as allies in the fight against dangerous drugs.

What the U.S. government should be pushing for, but isn’t, is better international public health law against fake drugs. There are treaties against fake currency and against narcotics, but not against fake drugs. This should change. A treaty against fake drugs would help countries currently awash in fake drugs to create laws based on public health considerations and not intellectual property rights. Right now, the rest of the world does not much care if it exports dangerous drugs to the U.S., because the U.S. pushes them to enforce intellectual property laws even when it might be counterproductive for them to do so. If we want safer supply chains, and fewer Avastin-type problems, we will have to help other countries improve their domestic public health laws.